PWC regulation wears out its welcome, says Rick Perrotta
CHARLOTTE, N.C. - Rick Perrotta’s putting his money on the line to challenge Medicare’s rule governing the replacement of power wheelchairs that fall apart due to wear and tear.
Medicare typically provides a beneficiary with a new power wheelchair once every five years, provided it would cost 60% of the new chair to repair the old. However, if the patient’s condition changes significantly or the chair is damaged beyond repair, stolen or lost, Medicare will waive the five-year rule. Perrotta believes Medicare should also waive the rule for a chair that falls apart due to heavy use.
To make his point, the president of Network Medical Supply in Charlotte, N.C., replaced a worn out chair last year before the five year threshold and is now awaiting an ALJ hearing on the denial.
“Some of these folks use their chairs like cars, and often times after three or four years their chairs are worn out, said Perrotta. “If you are putting 10,000 to 15,000 miles a year on a car, it will last quite a while. It’s a different story if you are going 25,000 miles a year.”
Ironically, while Medicare won’t pay for a new chair that wears out before the five-year threshold, it will pay thousands - sometimes as much as or more than the cost of a new chair - to repair it. Perrotta and other providers say that doesn’t make sense. In such a case, they ask, why not buy a new chair, take advantage of manufacturer warrantees, and make better use of Medicare’s money?
“If I’m an active adult I’m going to put a lot of mileage on a wheelchair,” said Tom Hafford, the owner of Mobility Dynamics in Cleburne, Texas. “Logic would say this has to be funded differently than a wheelchair for a geriatric patient.”
That’s what Perrotta desires: an exception to the rule that allows Medicare to consider individual circumstances.
Given today’s tight reimbursement climate and the tiny population of patients who fall into this category, the chance of Medicare approving such an exception appears slim to none, say other providers.
Perrotta’s going to find out.
“If the ALJ rules that policy trumps common sense, than it won’t get paid,” he said. “If on the other hand they are able to make exceptions based on common sense and the best of use of money, then I ought to win.”